According to national statistics, an average of 20 people per minute are physically abused by an intimate partner in the US alone. One in four women and one in nine men experience severe partner violence. These statistics do not even account for mental and emotional abuse—which can sometimes be just as harmful in the long run.
Abuse can be traumatic, and not surprisingly, trauma is linked to many mental health issues and symptoms. Trauma is most often associated with psychiatric conditions like post-traumatic stress disorder (PTSD). However, research also shows there’s a strong link with obsessive-compulsive disorder (OCD) as well. Estimates suggest that 19 to 31 percent of those with PTSD also have OCD.
OCD and PTSD are distinct mental health conditions (and treatment differs for each). However, they do share some notable common features—including intrusive thoughts.
What are intrusive thoughts?
Intrusive thoughts are unwelcome, negative thoughts, urges, or images that seem to come out of nowhere and are highly upsetting. Intrusive thoughts are not always the result of an underlying mental health condition; anyone can experience them occasionally. However, when they occur regularly, or lead to certain problematic and time-consuming behaviors, it’s normal to be concerned about what’s at the root of them and to understand how they manifest.
For instance, when a person with OCD experiences intrusive thoughts, they feel compelled to engage in compulsions. These are mental or physical acts, often repetitive, and performed to temporarily relieve distress. Some typical examples include excessive hand washing, cleaning, checking things, seeking reassurance, and asking the same question repeatedly. The problem with all these behaviors is that the relief they provide is short-lived. Obsessions always return when intrusive thoughts occur in the future, and a vicious cycle is created.
Can an abusive relationship contribute to intrusive thoughts?
Whether you have a mental health condition or not, trauma or stress resulting from an abusive relationship can indeed increase the chances that you’ll have distressing intrusive mental experiences. For example, trauma can lead to PTSD, which, among other things, is characterized by intrusive experiences like flashbacks and nightmares.
Stress can also precede and exacerbate the symptoms of OCD, including intrusive thoughts. One study found that compared to others, individuals with OCD were much more likely to report a stressful life event in the six months prior to the onset of their OCD. Other research has found that periods of high stress are associated with more severe OCD symptoms. More generally, intrusive thoughts thrive on negative experiences, and abuse definitely counts as one. Any particularly stressful event can make intrusive thoughts more frequent and distressing.
Let’s look at one example of intrusive thoughts following a period of abuse: Peggy was in an abusive relationship with her boyfriend for 3 years, and while she has been able to get back on her feet after the relationship ended, she’s started to notice distressing, unwanted intrusive thoughts. She fears that someone will break into her apartment and hurt her while she is sleeping. She also has thoughts that she will be attacked on her morning commute on the subway. Peggy finds herself engaging in compulsions like checking her locks repeatedly and spending money she doesn’t have to take a rideshare to work so she can avoid the subway.
Trauma and abuse may be factoring into Peggy’s increase in intrusive thoughts in a number of ways, creating a sense of danger and unease that latches onto intrusive thoughts that have no meaning at all on their own. But as for whether her intrusive thoughts are linked to a specific mental health issue, it would be necessary for Peggy to work with a therapist in order to determine if there are other symptoms present that might indicate a diagnosis of OCD, PTSD, or something else.
If you’re wondering if trauma and abuse cause OCD-related intrusive thoughts, the answer is a little more complicated. Despite the fact that OCD and abuse can be correlated, most people who have trauma and a history of abuse still don’t develop OCD. Instead, trauma, abuse, and other sources of stress can play a big part in setting the stage for OCD to develop, along with a complex range of other environmental and biological factors.
The difference between “intrusive thoughts” and other distressing thoughts about abuse
It is important to note the difference between an “intrusive thought” and other thoughts related to one’s past abuse or trauma. Let’s take the following as an example: Jennifer is in an abusive relationship with Ryan, who degrades her on a daily basis, calling her stupid, lazy, and a bad mother. Ryan also takes Jennifer’s phone while he is at work, and she does not have a car. She is basically trapped in her home.
Ryan has been physically abusive on one occasion, and Jennifer is worried. She becomes consumed with thoughts: “I should tell my mom what’s happening,” “Jennifer, just walk the 5 miles it takes to get to the store and make a call for help,” “He’s going to snap and kill you one day,” “Things are not going to get better.”
While these thoughts that Jennifer is having are distressing, it’s important not to confuse these with the intrusive thoughts of OCD. The intrusive thoughts that characterize OCD are ego-dystonic, meaning that they don’t align with a person’s values or intentions. Jennifer’s thoughts, on the other hand, are more likely in line with her desire for safety and security, and may be a necessary warning to Jennifer that she needs to take action. This is the complete opposite of experiencing intrusive thoughts related to OCD.
A common feature of OCD is the belief that dangerous or distressing thoughts require some response in order to stay safe, but that’s not the reality. It’s not necessary to take action (in the form of a compulsion) in response to a distressing intrusive thought. In Jennifer’s case, however, her safety may very well be in danger if she does not act on the thoughts—they may be uncomfortable, but they’re not intrusive or ego-dystonic. They actually provide useful and important information. The fear they bring can serve to motivate her to take action and leave her abusive situation.
Sometimes people have a hard time deciphering if they are in an abusive relationship or if their intrusive thoughts are making them question their relationship because of irrational fears. There’s no shame in needing to work with a therapist to help untangle these difficult questions.
How to cope with intrusive thoughts after an abusive relationship
Intrusive thoughts can be debilitating and interfere greatly with your ability to feel comfortable and at ease in daily life. The good news is that the fear and distress that come from these intrusive thoughts are treatable.
When it comes to freeing yourself from the impact of intrusive thoughts stemming from OCD, exposure and response prevention (ERP) therapy is the gold standard. As the name suggests, the technique calls for exposing people to situations that trigger their thoughts and obsessions, then preventing safety-seeking behaviors, or compulsions, that they do to feel relief. Most individuals who do ERP with a specialty-trained therapist experience a decrease in their symptoms, reduced anxiety and distress in response to intrusive thoughts, and can regain the parts of their lives that fear and compulsions have impacted.
When intrusive thoughts and safety-seeking responses like avoidance are the result of PTSD, on the other hand, there is an effective form of treatment that is similar to ERP called prolonged exposure, or PE. In PE, you gradually confront your memories, triggers, and fears, re-training your brain to understand that they pose no danger to you.
If you are struggling with intrusive thoughts after an abusive relationship, please know you are not alone. NOCD is a good place to have an evaluation. At NOCD, we treat all themes of OCD with ERP, as well as providing PE therapy for the many people who suffer from both conditions. We understand how hard it can be to reach out for help after experiencing the trauma of abuse—a NOCD therapist will meet you where you are and will help you to better understand your intrusive thoughts and how to deal with them in a safe and effective way.
One last thing
If you feel you are being abused or are in an unsafe situation, please reach out for help. You can reach out to local authorities or other support networks in your community. You can also contact The National Domestic Violence Hotline 24/7 at 1-800-799-7233 or text START to 88788 for help.